Pediatric nurses miss care more often in poor work environments, study finds

In a new study, researchers at the University of Pennsylvania School of Nursing's Center for Health Outcome and Policy Research and the Children's Hospital of Philadelphia examined the factors influencing the likelihood of missed nursing care in a pediatric setting. Their findings indicate that pediatric nurses with poor work environments and higher patient loads are more likely to miss required care.

"It's a complex and provocative subject when we talk about a health-care professional to be unable to give the care that's needed," said Eileen T. Lake, the Jessie M. Scott Endowed Term Associate Professor of Nursing and Health Policy at Penn Nursing. "There has been a lot of research on this topic but very little in pediatrics. Given that children are a particularly vulnerable population, our question was, To what extent do nurses in pediatrics miss care and how does it relate to levels of staffing and their work environment?"

Lake was first author on the paper, published this week in the journal Hospital Pediatrics, an official journal of the American Academy of Pediatrics. She collaborated with Penn Nursing's Linda H. Aiken, the Claire M. Fagin Leadership Professor in Nursing and the senior author on the paper, and Chief Nurse Paula D. Agosto and researchers Kathryn E. Roberts and Beth Ely at CHOP, as well as several colleagues now at other institutions.

To address their questions, the researchers relied on a survey data collected from 2,187 pediatric registered nurses in 223 hospitals between 2006 and 2008. Among other questions, nurses were asked whether they had omitted any required or necessary care activities due to a lack of time. They were also asked which activities were missed.

More than half of the nurses, which included staff from neonatal intensive care, pediatric intensive care and general pediatrics units, reported having missed at least one care activity. As has been found in other settings, care such as planning, comforting, teaching and counseling were missed most frequently, while pain management, treatments and procedures were missed rarely.

Notably, the fraction of nurses who said they failed to complete at least one activity varied considerably from hospital to hospital.

"Seeing that, we say, Okay then, there are some places where nurses can complete required care and others where they don't; that's a fundamental finding," said Lake, "The next question is, How does this relate to the nurses' work environment?"

The quality of the environment was determined from survey responses regarding nurses' relationships with physicians, whether they had a capable and supportive nurse manager, whether a nursing philosophy formed the basis of their care, whether their resources and staffing were adequate and the extent to which nurses participated in decision making at the hospital.

Categorizing hospitals into poor, mixed and better work environments, Lake and colleagues found that, while 61 percent of nurses in poor environments missed care, only 46 percent of those in better environments reported a missed care activity. Nurses in better environments also missed fewer care activities: 1.2 compared to 1.9 in poor environments.

Work load made a difference as well. For every additional patient, nurses were 70 percent more likely to miss care.

"The implications are that quality of care differs pretty significantly across institutions and that if we can either provide better staffing or better work environments or both that nurses can get their care completed," Lake said.

She noted that not only would ensuring that nurses have supportive work environments and manageable workloads improve care quality, but it could also improve care efficiency for hospitals.

"Completing tasks like providing education and discharge instructions helps parents have what they need to leave the hospital and feel comfortable doing so," Lake said.

Such attention to quality care is particularly significant in pediatric nursing, where patients have specific vulnerabilities.

"They're vulnerable developmentally, cognitively and in terms of their ability to express their symptoms and advocate for themselves," Lake said. "One of nursing's roles is an advocacy role, so offering quality care is especially key in this population."

Related Stories

There is a clear correlation between the number of registered nurses working at an acute hospital, the amount of nursing care that is left undone and the number of patients who die, a new thesis from Karolinska Institutet ...

Nurses working in hospitals around the world are reporting they are burned out and dissatisfied with their jobs, reported researchers at the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy ...

Hospitals that employ nurses who have specialty certification in wound, ostomy, and continence (WOC) care have lower rates of hospital-acquired pressure injuries (HAPIs), reports a study in the Journal of Wound, Ostomy and ...

Why are black older adults at higher risk of repeat hospital admission after a heart attack? Treatment at hospitals with higher rates of missed nursing care may be a contributing factor, reports a study in the May issue of ...

Most ward nurses say they are forced to ration care, and not do or complete certain aspects of it—including adequate monitoring of patients—because they don't have enough time, indicates research published online in BMJ ...

Why are black older adults at higher risk of repeat hospital admission after a heart attack? Treatment at hospitals with higher rates of missed nursing care may be a contributing factor, reports a study in the May issue of ...

Recommended for you

Policies aimed at removing sweets and crisps from checkouts could lead to a dramatic reduction to the amount of unhealthy food purchased to eat 'on the go' and a significant reduction in that purchased to take home, suggests ...

Children of parents who have alcohol use disorder are more likely to get married under the age of 25, less likely to get married later in life, and more likely to marry a person who has alcohol use disorder themselves, according ...

Folate deficiency creates more problems in connection with DNA replication than researchers had hitherto assumed, researchers from the University of Copenhagen show in a new study. Once a person lacks folate, the damage caused ...

Rudeness. Sarcastic comments. Demeaning language. Interrupting or talking over someone in a meeting. Workplace incivilities such as these are becoming increasingly common, and a new study from Portland State University and ...

A randomized trial by Vanderbilt-Ingram Cancer Center researchers indicates that magnesium optimizes vitamin D status, raising it in people with deficient levels and lowering it in people with high levels.

0 comments

Please sign in to add a comment.
Registration is free, and takes less than a minute.
Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.